By Dr. Varshali Mali, Gynaecology
Vaginal bleeding at the time of pregnancy can be really scary. But it isn’t as severe always especially during the first trimester where bleeding is quite normal. Yet still it is necessary to take measures lest it smells of an imminent miscarriage or something that demands an urgent treatment.
Let us take a look at the possible reasons of vaginal bleeding and when to see a doctor for each trimester.
First Trimester (first twelve weeks)
During this time, there are chances of miscaariage so speacial care is required. The different types of miscarriages are:
- Threatened Miscarriage – As the term suggests, in this condition the process of miscarriage might have begun. This is the initial stage of the process. In threatened miscarriage, there is slight bleeding accompanied by cramps and pain in the lower back, which is usually mild. The cervix (the lower part of the uterus) remains closed.
- Inevitable and Incomplete Miscarriage – In these conditions, there is bleeding along with an open cervix. When there is dilatation and thinning of the cervix, miscarriage is inevitable. In incomplete miscarriage, part of the tissue comes out and a part remains inside the uterus. In inevitable and incomplete abortions, the bleeding and cramps are more severe.
- Complete Miscarriage – Complete miscarriage is when the embryo has completely emptied from the uterus. The pain and bleeding reduce once the foetus is expelled. This can be confirmed through ultrasound.
- Missed Miscarriage – In Missed miscarriage, there is no sign of the life of the embryo and there is no expulsion of the embryo. It can be detected from the absence of heartbeat of the embryo found on ultrasound.
- Implantation bleeding (when the fertilized egg attaches itself to the uterus lining).
A. Threatened miscarriage – It is a term used to describe abnormal bleeding and abdominal pain that occurs while the pregnancy still continues
B. Inevitable miscarriage - It refers to the presence of an open internal os in the presence of bleeding in the first trimester of pregnancy.
C. Complete miscarriage – It is when the embryo or products of conception have emptied out of the uterus.
D. Missed miscarriage – It is known as missed miscarriage or silent miscarriage because you won’t realise that anything has gone wrong. You may not have had any of the usual signs of miscarriage, such as pain or bleeding.
- Cervical problems such as infection or inflammation. Cervix is the narrow lower end of the uterus that leads into the vagina.
- Ectopic pregnancy (ectopic pregnancy is when pregnancy occurred outside of uterine cavity e.g in fallopian tube or in ovary or in peritoneal cavity).
- Molar pregnancy (noncancerous tumor developing in the uterus region).
Pay a visit to your doctor whenever pregnant women notices bleeding accompanied by cramps, abdominal pain, chills or fever.
Second or third trimester (weeks 13 to 24)
- An incompetent cervix or weak tissues in the cervix that may contribute to the preterm birth of the baby.
- Preterm labor (when the labor pain starts before 37 completed weeks of pregnancy).
- Cervicitis (swelling of the cervix).
- Cervical erosion.
- Cervical polyp.
- Fibroids, etc.
The criterion for when to seek a medical help in this trimester is similar to that of the first trimester.
Third Trimester (weeks 25 to 40)
Common Vaginal Bleeding, added with mucous and a bloody or a pink vaginal discharge at the final weeks of pregnancy is an indication of an impending labor.
- Initiation of labor process.
- Placental abruption – Placenta forms in the uterus at the time of pregnancy for nourishing the baby. If this placenta gets removed completely or partially from the uterus’s inner wall before delivery, the condition is termed as Placental abruption.
- Placenta praevia (when placenta implanted in lower side of uterus).
- Uterine rupture where the uterus rips apart along the scarred line from an earlier C-section surgery. This state can be really life-threatening although rare.
- Intra-uterine death of the fetus.
Patient should visit to doctor when they notice bleeding, should not wait for one day. Bleeding anytime during pregnancy needs immediate attention.